NURSES’ AUTONOMY IN INTERACTING WITH RELATIVES THROUGH DIARY WRITING IN THE INTENSIVE CARE UNIT; AN EXPLORATIVE MIXED METHODS STUDY [NAIDIC-study]
An admission to the intensive care unit (ICU) is a major event for patients and their relatives and may lead to long-term psychosocial consequences, such as symptoms of anxiety and depression. ICU diaries support patients and families in understanding and processing the ICU stay by recording events and experiences in a personal narrative. Although digital ICU diaries are increasingly used, little is known about how ICU nurses shape these diaries and which professional considerations guide their writing.
Aim
The aim of this project was to gain insight into the choices ICU nurses make when writing in a digital diary and the factors influencing these choices. In addition, the project aimed to contribute to strengthening person-centred, psychosocial and relational care, as well as nursing autonomy.
Research design
The project followed an exploratory mixed-methods design, combining qualitative research (analysis of diary entries and semi-structured interviews) with quantitative research (online survey). The study was conducted in five Dutch hospitals.
Study objects
The study population consisted of a non-random sample of certified ICU nurses working in the participating ICUs for at least 16 hours per week. Recruitment was carried out in collaboration with nurse managers, who had no role in the study design, objectives, methods, or data analysis. Participation was voluntary and without personal benefit. Data sources included digital diary entries, interviews with ICU nurses, and survey data on digital skills, autonomy, and working conditions.
Intervention
The intervention involved the use of the digital Post-ICU diary, an existing application used in more than 20 ICUs in the Netherlands. From a person-centred care perspective, diary writing was approached as an act of care, supporting the construction of a meaningful narrative for patients and their relatives.
Results
The results show that digital diary writing goes beyond documentation and involves professional decision-making within a complex clinical and emotional context. ICU nurses made deliberate choices regarding content, wording, and timing, influenced by the fact that relatives could read the diary in real time. Clear guidelines, practical tools, and attention to emotional workload were essential for sustainable use.
Discussion
A limitation of the study is its primary focus on the nursing perspective; patient and family experiences were included indirectly. Nevertheless, the project demonstrates that digital diary writing makes a valuable contribution to psychosocial and relational essential care. The findings have implications for clinical practice, education, and policy, and provide concrete starting points for further implementation, embedding, and scaling up of digital diary use in ICU care.
Features
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Project number:
10040022230004
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- Duration: 100%
Duration: 100 %20232025 - Part of programme:
- Related funding round:
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Project lead and secretary:
dr. MMC van van Mol PhD
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Responsible organisation:
Erasmus Medisch Centrum
